| NPI | 1063069391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: GA rn284420) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA rn284420) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2019-08-21 |