| NPI | 1760763270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209008943) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: IA D164283) |
| 163WP0000X Registered Nurse, Pain Management (Licence: IL 209008943) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041353932) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2025-08-18 |