| NPI | 1780013094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 127665-30) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: WI 127665-30) |
| 163WH0200X Registered Nurse, Home Health (Licence: WI 127665-30) | |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2013-11-06 |