| NPI | 1609211713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: TX 794875) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN-72702) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2013-05-02 |