| NPI | 1861642365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 214079) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN 60010861) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2008-09-22 |