| NPI | 1255664835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD R104449) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC 055843) |
| 163W00000X Registered Nurse (Licence: DC 760055843) | |
| 163W00000X Registered Nurse (Licence: UT 93-224100-3102) | |
| 163W00000X Registered Nurse (Licence: VA 0001-152265) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |