| NPI | 1689097115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN500013043) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: DC RN500013043) |
| 164W00000X Licensed Practical Nurse (Licence: MD LP43666) | |
| 164W00000X Licensed Practical Nurse (Licence: DC LPN1007193) | |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2023-08-23 |