| NPI | 1629806872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VA 0001301746) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN500006216) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-10-08 |