| NPI | 1235392218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209019937) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238000087) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2021-12-22 |