| NPI | 1003700360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ 299481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95298291) |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2025-06-03 |