| NPI | 1740064146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: AZ 305618) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 194858) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2025-09-10 |