| NPI | 1942196589 | 
|---|---|
| Entity Type | Individual | 
| Gender | N/A | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201391508RN)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201391508)  | 
| 163WG0000X Registered Nurse, General Practice (Licence: OR 201391508RN)  | |
| Enumeration Date | 2025-06-17 | 
| Last Update Date | 2025-06-17 |