| NPI | 1053652545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 1001878) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 277000494) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2026-08-03 |