| NPI | 1164702429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2007002951) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041354981) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2011-08-18 |