| NPI | 1821425653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN59341) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0052273) |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2013-10-11 |