| NPI | 1366993016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 110187) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041431839) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |