| NPI | 1194700369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041169317) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IL 209-000670) |
| Enumeration Date | 2005-12-10 |
| Last Update Date | 2007-07-08 |