| NPI | 1568830644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.021950) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: IL 041394533) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2021-01-13 |