| NPI | 1689981342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 163401-30) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 041379456) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |