| NPI | 1902280688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VT 026.0035579) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001258231) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2015-07-13 |