| NPI | 1417119629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9233916) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN193101) |
| Enumeration Date | 2008-06-28 |
| Last Update Date | 2008-06-28 |