| NPI | 1235578279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 262718) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: NC 72896) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2013-06-24 |