| NPI | 1942027768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2023003896) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 1032859) |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-23 |