| NPI | 1669293890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WN0800X Registered Nurse, Neuroscience (Licence: IL 041548967) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-032573) |
| 363L00000X Nurse Practitioner (Licence: IL 209-032573) | |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2025-10-21 |