| NPI | 1225809692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SC 274775) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2480073) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2026-05-29 |