| NPI | 1174021893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209016539) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.016539) |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2025-03-17 |