| NPI | 1417832528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209033075) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041417130) |
| Enumeration Date | 2025-08-07 |
| Last Update Date | 2025-08-28 |