| NPI | 1396446647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209027047) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.027047) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2024-12-05 |