| NPI | 1457698169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209017185) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041398787) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2018-11-27 |