| NPI | 1215210158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209025153) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209025153) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA F0811297) | |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2024-10-28 |