| NPI | 1902665755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 3075882461) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 3075882423) |
| 163W00000X Registered Nurse (Licence: MI 3075882460) | |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-03-14 |