| NPI | 1225707904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: OR 200824518RN) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: OR 200842518RN) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2021-09-07 |