| NPI | 1548456122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277000409) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2004004425) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2025-02-07 |