| NPI | 1477018927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.018171) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IL 041.421877) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2020-07-11 |