| NPI | 1013679299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.024170) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 00000) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2021-10-18 |