| NPI | 1083145726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201508569RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60689100) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |