| NPI | 1841078011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: MO 2011019059) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: IL 041.448756) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-09-19 |