| NPI | 1144867441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209020242) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: IL 209020242) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2020-04-15 |