| NPI | 1679546899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041-094378) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 106108-030) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |