| NPI | 1215301817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: VA 0001245395) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NO09106000) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |