| NPI | 1710467881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: FL RN9394989) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30232) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |