| NPI | 1316968852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 16526) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN-064931) |
| 2471C3402X Radiologic Technologist Radiography (Licence: CA RHF 12519) | |
| 2471C3402X Radiologic Technologist Radiography (Licence: AZ CRT-3294) | |
| 376G00000X Nursing Home Administrator (Licence: NV 174) | |
| 376G00000X Nursing Home Administrator (Licence: NM 384) | |
| 376G00000X Nursing Home Administrator (Licence: AZ 662) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |