| NPI | 1619418209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC0400X Registered Nurse, Case Management (Licence: NE 80861) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NE 80861) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: NE 80861) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NE 80861) | |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2025-07-16 |