| NPI | 1649547613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM RN-73567) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN-9307653) |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2011-11-19 |