| NPI | 1669079018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.021681) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 209.021681) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2026-04-13 |