| NPI | 1730773201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95233854) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 763585) |
| 163W00000X Registered Nurse (Licence: ND R47807) | |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2021-02-25 |