| NPI | 1306255104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 09400695 RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00108905) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2014-08-05 |