| NPI | 1427549534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209017574) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 209017574) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209017574) | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2019-06-18 |