| NPI | 1982157780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209014500) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IL 041401733) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2016-07-27 |