| NPI | 1992018394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 193003) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN198784) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2010-07-14 |