| NPI | 1275216699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041476077) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019043435) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-08-11 |