| NPI | 1124397419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: GA RN128692) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN128692) |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2011-12-15 |