| NPI | 1851661979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 776308) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 190294-5) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2012-01-05 |