| NPI | 1396089769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: DC CPTH12 73) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: DC CPTH12 73) |
| Enumeration Date | 2012-11-24 |
| Last Update Date | 2012-11-24 |