| NPI | 1356736987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60481142) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: WA RN60481142) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2015-03-31 |