| NPI | 1326483280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209019035) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013013779) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2019-11-21 |