| NPI | 1306436787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209-022694) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209022694) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2026-03-04 |