NPI | 1104071117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 148495) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-80206-071) |
Enumeration Date | 2008-11-19 |
Last Update Date | 2008-11-19 |