| NPI | 1275996928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28157795A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041337622) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-03-31 |