| NPI | 1124183892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: MN R 114481-3) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WI 153695-030) |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2007-07-08 |