| NPI | 1245866375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.021041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.021041) |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2024-08-07 |