| NPI | 1528263225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0600X Registered Nurse Gerontology (Licence: WI 127494) |
| Additional Taxonomies | 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: WI 127494) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2007-07-08 |