| NPI | 1679925887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277.002043) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.014449) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2026-01-04 |