| NPI | 1538294897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374700000X Technician (Licence: OR 930064 OT-SC) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 083026191RN) |
| 163WX0800X Registered Nurse, Orthopedic (Licence: OR 930064) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2010-03-23 |