| NPI | 1447218326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209029418) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 74831) |
| 364S00000X Clinical Nurse Specialist (Licence: KS 53-74831) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2024-09-27 |