| NPI | 1720543838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277001620) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2019003452) |
| Enumeration Date | 2019-02-02 |
| Last Update Date | 2022-08-30 |