| NPI | 1437415809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN170808) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 556271) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2012-04-10 |