| NPI | 1871787986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AR R085088) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AR L48434) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2017-04-25 |