| NPI | 1194174730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: OR 201141129RN) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: ID N-35484) |
| Enumeration Date | 2016-06-04 |
| Last Update Date | 2016-06-04 |