| NPI | 1194038935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN188035) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: GA RN188035) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2010-07-22 |