| NPI | 1609012913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN137214) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN717859) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |