| NPI | 1093852055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 124172-30) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: WI 124172-030) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-10-26 |