| NPI | 1346298627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN179843) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN3201302) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-08 |