| NPI | 1801980263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28155912A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704237775) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-08 |