NPI | 1043769045 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN 9240423) |
Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: FL RN 9240423) |
Enumeration Date | 2016-10-02 |
Last Update Date | 2016-10-02 |