| NPI | 1790592616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN313569) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: GA RN313569) |
| Enumeration Date | 2024-12-13 |
| Last Update Date | 2024-12-13 |