| 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 |