| NPI | 1619767902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NC 244082) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 244082) |
| Enumeration Date | 2025-05-09 |
| Last Update Date | 2025-05-09 |