| NPI | 1043387673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WY 29655) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WY 4119) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2011-08-11 |