| NPI | 1316595747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021549) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041408668) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2020-09-07 |