| NPI | 1114458874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NE 59388) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 73451) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |