| NPI | 1902348931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9378593) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: FL 9378593) |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: FL 9378593) | |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2016-11-08 |