| NPI | 1932551256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OR 201602799LPN) |
| Additional Taxonomies | 163WU0100X Registered Nurse, Urology (Licence: OR 10013211) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2024-09-23 |