| NPI | 1952686446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: FL 9261307) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: PA 562576) |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2015-03-31 |