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 |