| NPI | 1912113200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 169532) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 571806) |
| 163W00000X Registered Nurse (Licence: FL RN9237319) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |