| NPI | 1982492245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SD R059061) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: SD P012489) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-04-28 |