| NPI | 1669280756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 870644) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61602498) |
| Enumeration Date | 2024-12-21 |
| Last Update Date | 2024-12-21 |