| NPI | 1265669022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 635667) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1015552) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2009-06-18 |