| NPI | 1225363682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209021590) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2021-03-31 |