| NPI | 1487077889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AL 1-107634) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN230148) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-24 |