| NPI | 1780446427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 15988-33) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: IL 041512395) |
| 163WE0003X Registered Nurse Emergency (Licence: WI 260346-30) | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-12-05 |