| NPI | 1639570476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209011280) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: HI APRN2709) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2025-04-29 |