| NPI | 1972106730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61069678) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 232423) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2022-09-19 |