| NPI | 1093330235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 821465) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202001987RN) |
| Enumeration Date | 2020-06-13 |
| Last Update Date | 2020-06-13 |