| NPI | 1235954728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209029192) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 0414153938) |
| Enumeration Date | 2024-11-19 |
| Last Update Date | 2025-03-04 |