| NPI | 1154155372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60377313) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60377313) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-08-29 |