| NPI | 1023753027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 202108218RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95154894) |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2022-06-29 |