| NPI | 1699148726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277000374) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2017009020) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2025-04-23 |