| NPI | 1447266333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2018022966) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209006084) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-10-20 |