| NPI | 1891290839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL F03180890) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL F03180890) |
| 363L00000X Nurse Practitioner (Licence: IN 28249457A) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2019-02-19 |