| NPI | 1124897707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: NY 807676) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: IL 041465479) |
| Enumeration Date | 2023-12-25 |
| Last Update Date | 2023-12-25 |