| NPI | 1013489384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95149168) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-87995) |
| 163W00000X Registered Nurse (Licence: AZ RN210374) | |
| 163W00000X Registered Nurse (Licence: FL RN9468338) | |
| 163W00000X Registered Nurse (Licence: IL 041.450696) | |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2018-12-26 |