| NPI | 1316777303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1008687) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.554690) |
| 163W00000X Registered Nurse (Licence: HI 114325) | |
| 163W00000X Registered Nurse (Licence: OR 201906974RN) | |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-23 |