| NPI | 1457751281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209011769) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209011769) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2023-08-15 |