| NPI | 1346850443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN205478) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61066442) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2020-08-04 |