| NPI | 1427546688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277000880) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11005547) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2022-06-15 |