| 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 |