| NPI | 1629873799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209032413) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041495685) |
| Enumeration Date | 2025-02-13 |
| Last Update Date | 2025-05-22 |