| NPI | 1700344702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN194044) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201707038RN) |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2019-03-08 |