| NPI | 1558459099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209006058) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-006058) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-08-14 |