| NPI | 1356127104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209028268) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: IL 041.405096) |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-10-12 |