| NPI | 1720528037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201609352RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ZZ 0953800) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-06 |