| NPI | 1134636228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.017085) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 10933) |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2022-12-16 |