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 |