| NPI | 1083301022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209.027174) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.404272) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-04-20 |