| NPI | 1437722394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71011355A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209026969) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11024047) | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2025-10-10 |