| NPI | 1215335153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1005219) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI 74258) |
| 163WC0400X Registered Nurse, Case Management (Licence: CA 95041888) | |
| 164W00000X Licensed Practical Nurse (Licence: DC LPN8010) | |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-10 |