| NPI | 1093175226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP8931) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IL 209013816) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2020-11-25 |