| NPI | 1306203914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28120937A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041281492) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |