| NPI | 1568591915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: TX 748838) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI 51529) |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2010-12-27 |