| NPI | 1861221459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN312252) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2471128) |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2024-07-31 |