| NPI | 1194015388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209029691) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227011698) |
| Enumeration Date | 2011-04-09 |
| Last Update Date | 2024-05-10 |