NPI | 1679087605 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK 188881) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AK 127403) |
Enumeration Date | 2017-11-29 |
Last Update Date | 2022-02-16 |