| NPI | 1194077305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95000250) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209009714) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2016-02-10 |