| NPI | 1144832049 |
|---|---|
| Former Name | TSHIABA MWENGELEKAYI RUSSELL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11008517) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2021-01-27 |