| NPI | 1871955161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: LA RN150263) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 395678) |
| 163W00000X Registered Nurse (Licence: KY 1137580) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-03-24 |