| NPI | 1407267479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60401717) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 674122) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-05-13 |