NPI | 1215566435 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209021255) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041409625) |
Enumeration Date | 2020-04-08 |
Last Update Date | 2021-01-21 |