| NPI | 1568181329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209028544) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 32009) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2024-03-09 |