| NPI | 1962620906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: MO 072996) |
| Additional Taxonomies | 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: KS 74686) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |