| NPI | 1538370663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: MT 19495) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MT 19495) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |