| NPI | 1518448869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VA 0001282656) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.464823) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-08-24 |