| NPI | 1902479926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209023852) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209023852) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: IL 041383616) | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2026-04-16 |