| NPI | 1679766836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: OR 200741615RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200741615RN) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-23 |