| NPI | 1942575881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: OR 094000338) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 8139) |
| Enumeration Date | 2012-03-10 |
| Last Update Date | 2012-09-28 |