| NPI | 1972774230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 178794) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: CO 178794) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2008-03-14 |