| NPI | 1154765279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SC 201467) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN622873) |
| 163W00000X Registered Nurse (Licence: WA RN60176013) | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2013-04-19 |