| NPI | 1427496868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209010474) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ME CNP151044) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2334824) | |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2024-11-11 |