| NPI | 1770037947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209014697) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.014697) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2026-05-11 |