| NPI | 1508092073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse Emergency (Licence: AZ RN 143120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN 143120) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2009-06-10 |