| NPI | 1558614891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SC 54211) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: SC 54211) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2012-10-24 |