| NPI | 1558839084 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277001771) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209018307) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2024-12-05 |