| NPI | 1730614579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61217405) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: WA PC60752642) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2024-02-10 |