| NPI | 1578739702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse Medical-Surgical (Licence: AZ RN096243) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: AZ RN096243) |
| 163WX0800X Registered Nurse Orthopedic (Licence: AZ RN096243) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2008-05-07 |