| NPI | 1356701775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN 60474446) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN 82219) |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2016-02-26 |