| NPI | 1427648849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AL 1-150282) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 38921) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-01-20 |