| NPI | 1124853817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ 222974) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041442145) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-05 |