| NPI | 1578457727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD R269535) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN741021) |
| 163W00000X Registered Nurse (Licence: TX 1074648) | |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-06-04 |