| NPI | 1902179252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201340322RN) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OR 201030517LPN) |
| 164X00000X Licensed Vocational Nurse (Licence: CA 235539) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2020-08-17 |