| NPI | 1912641879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.025250) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 041.408204) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-05-27 |