| NPI | 1700083912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: OK 0083168) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 3639) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2007-07-08 |