| NPI | 1508174079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041386114) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 247217-30) |
| Enumeration Date | 2010-09-18 |
| Last Update Date | 2026-05-14 |