| NPI | 1073318358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.032032) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 16510-33) |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-07-11 |