| NPI | 1316126980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: AK 21966) |
| Additional Taxonomies | 163WF0300X Registered Nurse, Flight (Licence: AK 21966) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2012-04-30 |