| NPI | 1558146001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041.465731) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 1105101-30) |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2023-08-31 |