| NPI | 1972261196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: AZ RN215721) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: AZ RN215721) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: AZ RN215721) | |
| Enumeration Date | 2021-12-05 |
| Last Update Date | 2021-12-05 |