| NPI | 1023737921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2495972) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 266264) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2022-08-24 |