NPI | 1306611207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209029162) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041470973) |
Enumeration Date | 2023-11-20 |
Last Update Date | 2024-07-31 |