| NPI | 1306110812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK 129218) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2018-11-20 |