| NPI | 1619013315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: OR 200342299RN) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: WA RN00121912) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2012-10-17 |