| NPI | 1083120448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: FL RN9474735) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9474735) |
| 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: FL RN9474735) | |
| 163WG0000X Registered Nurse General Practice (Licence: FL RN9474735) | |
| 163WI0500X Registered Nurse Infusion Therapy (Licence: FL RN9474735) | |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2017-12-21 |