| NPI | 1952246878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9414829) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 807474) |
| 163W00000X Registered Nurse (Licence: WA 60986738) | |
| Enumeration Date | 2026-04-20 |
| Last Update Date | 2026-04-20 |