| NPI | 1285264523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277003492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 209020746) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2024-11-05 |