| NPI | 1356659320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV RN71443) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28116732A) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2013-12-16 |