| NPI | 1982950523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 3199112) |
| Additional Taxonomies | 372500000X Chore Provider (Licence: FL 3199112) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2012-08-01 |