| NPI | 1164057014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345734) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209020877) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-03-18 |