| NPI | 1265126502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.029741) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F352085-01) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2024-05-22 |