| NPI | 1144688680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9279980) |
| Additional Taxonomies | 3747P1801X Technician Personal Care Attendant |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |