| NPI | 1649088436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2494063) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9714800) |
| Enumeration Date | 2024-12-25 |
| Last Update Date | 2026-07-14 |