| NPI | 1841089257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CT 134224) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 982729) |
| Enumeration Date | 2025-05-02 |
| Last Update Date | 2025-05-02 |