| NPI | 1144655275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: FL RN9364252) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9364252) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2021-04-23 |