| NPI | 1164028296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 8215) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209022406) |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2024-08-20 |