| NPI | 1356792485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SD R040461) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60600013) |
| 163W00000X Registered Nurse (Licence: MT NUR-RN-LIC-97913) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2016-06-30 |