| NPI | 1053362988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 574764) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 673689) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |