| NPI | 1770880973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.001148) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209008681) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2021-05-05 |