| NPI | 1366573032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN151988) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN72655) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-12-06 |