| NPI | 1376866673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse Administrator (Licence: AZ 073221) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TX 649473) |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2010-03-02 |