| NPI | 1194331868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.021225) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11017614) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2024-01-19 |