| NPI | 1629424833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041.440216) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 731767) |
| 163W00000X Registered Nurse (Licence: WI 241285-30) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2020-12-22 |