| NPI | 1760139018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209029393) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28250766A) |
| Enumeration Date | 2022-03-07 |
| Last Update Date | 2024-03-10 |