| NPI | 1730043134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041479678) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209034541) |
| Enumeration Date | 2025-12-11 |
| Last Update Date | 2026-01-23 |