| NPI | 1194519223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA LP60683042) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA LP60683042) |
| Enumeration Date | 2025-04-04 |
| Last Update Date | 2025-04-04 |