| NPI | 1285369314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 041456254) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11019429) |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2024-12-19 |