| NPI | 1457696833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 202997) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2272802) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2014-10-14 |