| NPI | 1942194972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9520435) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 103713-G) |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-06-04 |