| NPI | 1699939389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VA 0001163547) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC 0000000not sure) |
| 163W00000X Registered Nurse (Licence: MD R161391) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2008-07-16 |