| NPI | 1871256792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209024302) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 041406091) |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2023-08-25 |