| NPI | 1598019499 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: NV RN38717)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN38717)  | 
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NV RN38717)  | |
| Enumeration Date | 2012-10-31 | 
| Last Update Date | 2012-10-31 |