NPI | 1346120193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209033124) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 209.033124) |
Enumeration Date | 2025-09-03 |
Last Update Date | 2025-10-09 |