| NPI | 1033659081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209015665) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2023031644) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2024-07-10 |