NPI | 1053964395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209027656) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11003002) |
Enumeration Date | 2019-07-16 |
Last Update Date | 2023-09-19 |