| NPI | 1548151475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209033922) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 1703833) |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2025-12-19 |