| NPI | 1821530304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209016200) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: IL 041405030) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: MO 2012004299) | |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2021-05-17 |