| NPI | 1174417281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 202202365RN) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: OR 202202365RN) |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-06-04 |