| NPI | 1689331191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 236232) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 24933404) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2021-11-18 |