| NPI | 1215441779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: RI RN58354) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 922075) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2017-11-20 |