NPI | 1982391967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: KS 13-113388-031) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011037697) |
Enumeration Date | 2023-04-20 |
Last Update Date | 2023-04-20 |