| NPI | 1154722585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN162022) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: GA RN162022) |
| 163WP0000X Registered Nurse, Pain Management (Licence: GA RN162022) | |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2014-09-04 |