| NPI | 1164885745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209013700) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.013700) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2025-08-12 |