| NPI | 1194728618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 163WG0000X Registered Nurse General Practice (Licence: FL 2806062) |
| Additional Taxonomies | 163WI0500X Registered Nurse Infusion Therapy (Licence: FL 2806062) |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2007-07-08 |