| NPI | 1619819588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2537809) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND 200535) |
| Enumeration Date | 2026-04-08 |
| Last Update Date | 2026-04-08 |