| NPI | 1275391922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0200X Registered Nurse, Pediatrics (Licence: IL 041428458) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209029060) |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |