| NPI | 1538681572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209016141) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: IL 277001306) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2023-10-11 |