| NPI | 1285460998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VA 0001203749) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: VA 0001203749) |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2025-02-10 |