| NPI | 1235725276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209028146) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0996295-NP) |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2023-10-30 |