| NPI | 1104135870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP2800X Clinical Nurse Specialist, Perioperative (Licence: WA 080904) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00055805) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2012-07-27 |