| NPI | 1578942017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201407695RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041402049) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2015-05-28 |