| NPI | 1669721015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 242011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1022102) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2012-08-30 |