| NPI | 1235680810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: UT 9240518-3102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60651090) |
| 163W00000X Registered Nurse (Licence: CA 95101843) | |
| 163W00000X Registered Nurse (Licence: AK 109502) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |