| NPI | 1073491346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209033256) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: IL 041541036) |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-09-17 |