| NPI | 1891302956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277.001944) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11009319) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2025-08-18 |