| NPI | 1649056573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 814713) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 727742) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2023-09-06 |