| 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 |