| NPI | 1770901241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61063140) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LP00059842) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2022-03-28 |