| NPI | 1003119868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201040792RN) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 201040792RN) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2014-03-11 |