| NPI | 1700476959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WW0000X Registered Nurse, Wound Care (Licence: VA 0001282511) |
| Additional Taxonomies | 163WX1500X Registered Nurse, Ostomy Care (Licence: VA 0001282511) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2022-04-04 |