| NPI | 1376374561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 10027219) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704301083) |
| 163W00000X Registered Nurse (Licence: WI 260865-30) | |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2024-08-30 |