| NPI | 1356447262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN087061) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 281505) |
| 364S00000X Clinical Nurse Specialist (Licence: AZ AP1617) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-09 |