| NPI | 1538757695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.020666) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL F12190311) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-09-08 |