| NPI | 1407282635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KS 14-77651-121) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R050048) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2013-09-19 |