| NPI | 1972694701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 124041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WI 2068) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |