| NPI | 1063808632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201608698RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK NURR38019) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2017-02-01 |