| NPI | 1508421421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60775994) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LP60709382) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2021-01-27 |