| NPI | 1558924233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9615399) |
| Additional Taxonomies | 104100000X Social Worker |
| 363A00000X Physician Assistant (Licence: PR 000865-P.A.) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2022-12-27 |