| NPI | 1306211677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209013718) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015042831) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA a171867) | |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2022-11-10 |