| NPI | 1619301892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: LA RN128552) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R886652) |
| 163W00000X Registered Nurse (Licence: AL 1-116345) | |
| Enumeration Date | 2013-08-24 |
| Last Update Date | 2013-08-24 |