| NPI | 1043087927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN00171315) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: WA RN00171315) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |