| NPI | 1871064220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: CA 95149758) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: IL 041459379) |
| 163WS0200X Registered Nurse, School (Licence: ME RN72054) | |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2018-12-11 |