| NPI | 1114510260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: UT 11762134-3102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 11762134-3101) |
| 164W00000X Licensed Practical Nurse (Licence: UT 11762134-3101) | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2023-06-01 |