| NPI | 1285208561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-023781) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IL 041433768) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2022-04-22 |