| NPI | 1831493063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: TX 345782195) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: TX 4765290876) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2011-01-03 |