| NPI | 1275321242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60956855) |
| Additional Taxonomies | 163WG0100X Registered Nurse, Gastroenterology (Licence: WA RN60956855) |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-04-29 |