| NPI | 1649613928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ 110966) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ 110966) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2013-04-17 |