| NPI | 1215103387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: WI 156811-030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 156811-030) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2008-05-07 |