| NPI | 1295109726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN2852382) |
| Additional Taxonomies | 163WR0400X Registered Nurse Rehabilitation (Licence: FL RN2852382) |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2015-12-11 |