| NPI | 1467782268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WY 21801) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 192382) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2009-12-30 |