| NPI | 1750913950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse Community Health (Licence: OR 202000195RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202000195RN) |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2020-02-06 |