| NPI | 1184586430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IA 115640) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041356163) |
| Enumeration Date | 2025-11-25 |
| Last Update Date | 2025-11-25 |