| NPI | 1477634905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN00067539) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: WA NT00000636) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |