| NPI | 1881354983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1630426) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 637489) |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2021-12-30 |