| NPI | 1639834104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD R224314) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MD R224314) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |