| NPI | 1063455541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AL 1-083260) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 5064) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2016-11-26 |