| NPI | 1164041257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VT 026.0051651) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 763488-1) |
| 163W00000X Registered Nurse (Licence: NH 079328-21) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2020-04-09 |