| NPI | 1063168854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN.61123743) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1665939) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2022-03-01 |