| NPI | 1760022180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209020686) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 209020686) |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2024-10-03 |