| NPI | 1629007596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse Emergency (Licence: GA RN107131) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN107131) |
| 163WP2201X Registered Nurse Ambulatory Care (Licence: GA RN107131) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2010-09-21 |