| NPI | 1568626968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9247241) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2010-01-20 |