| NPI | 1538901368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041.378725) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 133793-30) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2024-06-11 |