| NPI | 1255798443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: PR 70672) |
| Additional Taxonomies | 111NR0400X (Licence: PR 70672) |
| 282NR1301X General Acute Care Hospital, Rural (Licence: PR 70672) | |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |