NPI | 1033767082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN336687) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209019079) |
Enumeration Date | 2019-09-03 |
Last Update Date | 2025-07-22 |