NPI | 1316274012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 041247783) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209007705) |
Enumeration Date | 2009-11-17 |
Last Update Date | 2019-08-20 |