| NPI | 1265057327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9599547) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704393276) |
| 163W00000X Registered Nurse (Licence: MS R915554) | |
| Enumeration Date | 2020-06-14 |
| Last Update Date | 2022-09-22 |