| NPI | 1417943903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A080476) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209002893) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-03-07 |