| NPI | 1750894952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.003329) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 277003329) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2025-01-15 |