| NPI | 1972203297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA 60222011) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WA 60222011) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-20 |