| NPI | 1902348360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28231782A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-134114) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2016-12-30 |