| NPI | 1700764917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: NV 893441) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-11-11 |