| NPI | 1275909301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209014555) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041443589) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2019-07-24 |