| NPI | 1609631522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KY 4015274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 268152) |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2024-02-20 |