| NPI | 1104028828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN.RN.61490907) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704234655) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2025-11-18 |