| NPI | 1598270886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: PR 2530) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PR 33625) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2017-12-08 |