| NPI | 1932449790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9577984) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5185858) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2025-10-02 |