| NPI | 1265979918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201609966RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN83860) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2017-01-19 |