| NPI | 1669879276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WS0200X Registered Nurse School (Licence: WA RN60489295) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: WA LP60429900) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2014-11-25 |