| NPI | 1356778096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN2935522) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN173997) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2013-09-26 |