| NPI | 1174193312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209023492) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A185317) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2025-08-15 |