| NPI | 1891302956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.022435) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11009319) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2022-04-25 |