| NPI | 1386994812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209009800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041342995) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2012-09-12 |