| NPI | 1740629187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: MO 2003017737) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: KS 14121954022) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |