| NPI | 1124583760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: MD R199643) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: MD R199643) |
| 163WH0200X Registered Nurse, Home Health (Licence: MD R199643) | |
| 163WH0500X Registered Nurse, Hemodialysis (Licence: MD R199643) | |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2019-02-07 |