| NPI | 1053276444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: UT 6684236-3102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.583907) |
| Enumeration Date | 2025-12-18 |
| Last Update Date | 2025-12-18 |