| NPI | 1417473141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209016027) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209016027) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2026-04-06 |