| NPI | 1568846343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.013669) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7944) |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2021-12-20 |