| NPI | 1003092669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 120912) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN128685) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-14 |