| NPI | 1801390034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC 1035173) |
| Additional Taxonomies | 251E00000X Home Health (Licence: MD R4216P) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2021-11-03 |