| NPI | 1477388924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2012001895) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9470890) |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-09-04 |