| NPI | 1013869163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: OR 202213459RN) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OR 202213459RN) |
| Enumeration Date | 2026-02-11 |
| Last Update Date | 2026-04-03 |