| NPI | 1093995565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN pending) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209009450) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2017-05-11 |