| NPI | 1811828635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209035054) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209035054) |
| Enumeration Date | 2026-05-28 |
| Last Update Date | 2026-08-05 |