| NPI | 1316349921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277000489) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95001308) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2024-02-21 |