| NPI | 1366621245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61079235) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 644213) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2021-08-20 |