| NPI | 1124180708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209009090) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: IL 041-249147) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-11-09 |