| NPI | 1518308253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN 60721245) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 098007012RN) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2017-03-07 |