| NPI | 1295416543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209030426) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: IL 041467924) |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2024-09-11 |