| NPI | 1750789129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 0199442) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.418247) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2014-12-16 |