| NPI | 1457891806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277000188) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209016021) |
| 363L00000X Nurse Practitioner (Licence: IN 71008122A) | |
| Enumeration Date | 2017-03-05 |
| Last Update Date | 2022-12-29 |