| NPI | 1124359518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PR 027474) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9201412) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2010-01-25 |