| NPI | 1316539356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209022735) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209022735) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2022-06-03 |