| NPI | 1235522806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209023723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041477546) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2023-01-18 |