| NPI | 1174522825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209000227) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209000227) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2018-11-02 |