| NPI | 1922726447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 1101970-30) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2390967) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2024-01-30 |