| NPI | 1770147480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.019746) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL F03190845) |
| Enumeration Date | 2019-04-28 |
| Last Update Date | 2024-09-16 |