| NPI | 1497810410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: FL 9163548) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: MA 239660) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |