| NPI | 1114600368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: AZ RN091710) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN091710) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-08-14 |