| NPI | 1609703479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209035722) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041501111) |
| Enumeration Date | 2026-05-06 |
| Last Update Date | 2026-06-04 |