| NPI | 1245735497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209017407) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018003488) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2022-06-30 |