| NPI | 1083266878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL F06190486) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.019928) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2021-10-05 |