| NPI | 1760760904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209008922) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041361420) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2019-10-07 |