| NPI | 1700383445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9288865) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9288865) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: FL 9288865) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2018-04-10 |