| NPI | 1245787134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PR 32573 A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 57285 P) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-19 |