| NPI | 1649731910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209019464) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL Student) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-11-06 |