| NPI | 1396476230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209028143) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041392887) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2023-09-06 |