| NPI | 1073071007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9639167) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5236771) |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2023-10-12 |