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 |