| NPI | 1790045722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209010476) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R877834) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2014-12-29 |