| NPI | 1841709862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277002544) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209016631) |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2025-10-07 |