| NPI | 1184066763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 200843125RN) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: OR 200843125RN) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2025-07-10 |