| NPI | 1568824043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN200002412) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: DC LPN1004106) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2023-12-21 |