| NPI | 1932633443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209015660) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017001794) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-03-17 |