| NPI | 1346706389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201811325RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 923952) |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2019-04-03 |