| NPI | 1962265744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 200841670rn) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA rn60283278) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-02-05 |