| NPI | 1407082480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WW0000X Registered Nurse Wound Care (Licence: OR 200542242RN) |
| Additional Taxonomies | 163WW0000X Registered Nurse Wound Care (Licence: WA RN 60087413) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2009-06-04 |