| NPI | 1194350462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2491690) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 199721) |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2025-08-21 |