NPI | 1336836907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209029879) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041458951) |
Enumeration Date | 2023-04-24 |
Last Update Date | 2025-02-17 |