| NPI | 1962005470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9422839) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95219233) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |