| NPI | 1578867206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RNOO141825) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 084053663RN) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2011-01-10 |