| NPI | 1629958160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1400X Registered Nurse, College Health (Licence: PR 92814-G) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 92814-G) |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-22 |