| NPI | 1396282448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209016175) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704322025) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2019-11-27 |