| NPI | 1063702975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN087426) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: AZ RN030419) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2011-04-12 |