| NPI | 1992582944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1018354) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704283863) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2023-09-13 |