| NPI | 1891963773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704216292) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041-350175) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2008-02-13 |