| NPI | 1932715570 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209021324) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021324) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2021-08-03 |