| NPI | 1780474262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1666318) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95285799) |
| Enumeration Date | 2025-05-08 |
| Last Update Date | 2025-05-08 |