| NPI | 1265016513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 209.023086) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209023086) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2024-05-16 |