| NPI | 1831072164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209033363) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041428618) |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-12-23 |