| NPI | 1326400037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 58724) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209013979) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-01-24 |