| NPI | 1134582026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: PR 78389) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 78389) |
| 163WG0000X Registered Nurse, General Practice (Licence: PR 78389) | |
| 163WR0400X Registered Nurse, Rehabilitation (Licence: PR 78389) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2016-03-30 |