| NPI | 1033664073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: NM 372972) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-77826) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2016-08-19 |