| NPI | 1699391482 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041.483766) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-151512-061) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |