| NPI | 1023629623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: MD R204321) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD r204321) |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-08-17 |