| NPI | 1003354085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1640930) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 705686-1) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |