| NPI | 1235335217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1050317) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MD LP41126) |
| 374U00000X Home Health Aide (Licence: DC HHA8909) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2019-05-09 |