| NPI | 1417712266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9379901) |
| Additional Taxonomies | 163WS0200X Registered Nurse School (Licence: FL 001717) |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2024-02-20 |