| NPI | 1063179141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209024355) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041414847) |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2022-04-25 |