| NPI | 1104217249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364S00000X Clinical Nurse Specialist (Licence: TN 19821) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 140859) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-05-04 |