| NPI | 1497905558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK NURR36135) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 288076-3102) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2024-05-23 |