| NPI | 1346607470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 229689-6) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN192194) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |