| NPI | 1922795319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KS 14-85187-112) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 120441) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-18 |