| NPI | 1073970406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN217944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL Unknown/Expired) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2016-01-15 |