| NPI | 1134412059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0100X Registered Nurse, Gastroenterology (Licence: OR 201042388RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201042388RN) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2011-05-25 |