| NPI | 1043443757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041-352348) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 157635-030) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2024-12-22 |