| NPI | 1528575248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041405733) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 893242) |
| 163W00000X Registered Nurse (Licence: GA RN273461) | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-01-03 |