| NPI | 1306332820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041409249) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 133308) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-07-09 |