| NPI | 1407671332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 716341) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 309476) |
| 163W00000X Registered Nurse (Licence: CA 660684) | |
| Enumeration Date | 2024-11-16 |
| Last Update Date | 2024-11-16 |