| NPI | 1407425473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: ID 64316) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: ID 64316) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-06-23 |