| NPI | 1487176418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9368693) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN234881) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2021-02-12 |