| NPI | 1205523909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60866348) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95265500) |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2023-04-21 |