| NPI | 1194278929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209014615) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209014615) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71013785A) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2023-08-02 |