| NPI | 1639519135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: VA 0001244547) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: VA 0001244547) |
| 163WH0500X Registered Nurse, Hemodialysis (Licence: VA 0001244547) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2017-03-28 |