| NPI | 1770289795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 202002923RN) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: OR 202002923RN) |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2023-02-01 |