| 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 |