NPI | 1558826735 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209018729) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.018729) |
Enumeration Date | 2019-02-01 |
Last Update Date | 2022-06-10 |