| NPI | 1871228585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WI0500X Registered Nurse, Infusion Therapy (Licence: FL 9538797) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: FL 9538797) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2022-07-18 |