| NPI | 1962733410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: IA 087661) |
| Additional Taxonomies | 163WI0500X Registered Nurse, Infusion Therapy (Licence: IA 087661) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2010-01-22 |