| NPI | 1083852701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse Community Health (Licence: OR 200940069RN) |
| Additional Taxonomies | 163WR0400X Registered Nurse Rehabilitation (Licence: OR 200940069RN) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2009-02-03 |