| NPI | 1962902098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 891112) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61233462) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2021-12-07 |