| NPI | 1922612514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1031647) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R214353) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |