| NPI | 1275951352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN 9431349) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 9713) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2016-08-24 |