| NPI | 1114440179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277002840) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209015848) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2024-01-05 |