| NPI | 1235532268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OK 100293) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 775271) |
| Enumeration Date | 2014-10-05 |
| Last Update Date | 2015-07-26 |