| NPI | 1336399484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 759554) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 499985) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2008-09-25 |