| NPI | 1689141277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: WY 33858) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: WY 33858) |
| 163WE0003X Registered Nurse Emergency (Licence: WY 33858) | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2018-11-01 |