| NPI | 1609911718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: WI 126501) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 126501) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-10-22 |