| NPI | 1982425542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: CA 95251779) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN126806) |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-10-17 |