| NPI | 1821850546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD R239918) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1049542) |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-01-29 |