| NPI | 1083109565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209017931) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: IL 041411157) |
| 363L00000X Nurse Practitioner (Licence: IL 209017931) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2022-10-03 |