| NPI | 1427630300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: WA 00122148) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OR 087003108) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-21 |