| NPI | 1790941938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN RN0000138728) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TN RN0000138728) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2008-08-06 |