| NPI | 1609069954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041-348127) |
| Additional Taxonomies | 227900000X Respiratory Therapist, Registered (Licence: IL 194.002475) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |