| NPI | 1134464712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK 117491) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 657175) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2017-01-09 |