| NPI | 1912060302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL ARNP1852152) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: FL ARNP1852152) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-08 |