| NPI | 1659837367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-018990) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IL 041417848) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2023-06-22 |