| NPI | 1215815899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IA 152421) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: IA 152421) |
| Enumeration Date | 2025-08-22 |
| Last Update Date | 2025-09-05 |