| NPI | 1528825395 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 163WD0400X Registered Nurse, Diabetes Educator (Licence: FL RN9356329)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9356329)  | 
| Enumeration Date | 2024-02-28 | 
| Last Update Date | 2024-02-28 |