| NPI | 1750179172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: WA RN61302240) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202213493RN) |
| Enumeration Date | 2025-04-26 |
| Last Update Date | 2025-10-10 |