| NPI | 1508382375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 2017002961) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 209.016135) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2022-02-28 |