| NPI | 1093117707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9483340) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN-88979) |
| 164W00000X Licensed Practical Nurse (Licence: FL PN5211645) | |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2018-10-26 |