| NPI | 1154963700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: WA RN60285802) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: WA RN60285802) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2019-10-16 |