| NPI | 1821540121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2478086) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: NY 326958) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2020-11-08 |