| NPI | 1003663238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61151055) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201900571RN) |
| 163W00000X Registered Nurse (Licence: MO 2017021326) | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-05-06 |