| NPI | 1033519418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201402142RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-75999) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2014-09-04 |