| NPI | 1659737971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MT nur-rn-lic-196938) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2022-10-04 |