| NPI | 1184166001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.000904) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209015033) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2023-03-23 |