| NPI | 1801168349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WI0500X Registered Nurse Infusion Therapy (Licence: IL 041359711) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: IL 041359711) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |