| NPI | 1710312913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV RN44717) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 715327) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2013-09-06 |