| NPI | 1992392807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704310639) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61109233) |
| Enumeration Date | 2020-12-26 |
| Last Update Date | 2025-05-05 |