| NPI | 1215491915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209018723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 209018723) |
| Enumeration Date | 2019-01-27 |
| Last Update Date | 2019-10-28 |