| NPI | 1629614631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209020557) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL F11190685) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2022-07-27 |