| NPI | 1598948028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: WV 49188) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1102771) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2007-12-06 |