| NPI | 1871018564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 243446-30) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WI 321915-31) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2022-07-21 |