| NPI | 1285621847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 143182) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209013625) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2023-01-17 |