| NPI | 1003999293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209001480) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IL 041-224149) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209001480) | |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: IL 209000502) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2024-07-24 |