| NPI | 1114397858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN RN0000102332) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN120445) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2015-10-06 |