NPI | 1205394897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2015020569) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041429937) |
Enumeration Date | 2019-03-04 |
Last Update Date | 2019-03-14 |