| NPI | 1952026346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: PA 624730) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: PA 626730) |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2022-10-07 |