| NPI | 1861738486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 202106698RN) |
| Additional Taxonomies | 251B00000X Case Management (Licence: WY 132080700) |
| Enumeration Date | 2012-12-31 |
| Last Update Date | 2021-07-12 |