| NPI | 1861552481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209003091) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 041-258740) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-03-22 |