| NPI | 1194447516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MI 4704363526) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704363526) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2022-09-13 |