| NPI | 1801320700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041288247) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 2990822) |
| 163W00000X Registered Nurse (Licence: AZ 145221) | |
| 163W00000X Registered Nurse (Licence: NV 86587) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-18 |