| NPI | 1518368349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: OH 371941) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9359997) |
| 163W00000X Registered Nurse (Licence: CA 95026136) | |
| 163W00000X Registered Nurse (Licence: NV 77804) | |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2014-09-11 |