| NPI | 1952688269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2000151395) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-90533-012) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |