| NPI | 1972041119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 197661) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 97670) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2023-01-03 |