| NPI | 1497500573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1118188) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041543051) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-04-22 |