| NPI | 1649370776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: AZ RN098085) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 985962) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-12-27 |