| NPI | 1720934110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WW0000X Registered Nurse, Wound Care (Licence: SC 269757) |
| Additional Taxonomies | 163WH0500X Registered Nurse, Hemodialysis (Licence: SC 269757) |
| Enumeration Date | 2026-03-07 |
| Last Update Date | 2026-03-07 |