| NPI | 1790381168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021228) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209021228) |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2025-12-03 |