NPI | 1457087900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209025284) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-025284) |
363LP2300X Nurse Practitioner, Primary Care (Licence: IL 041449223) | |
Enumeration Date | 2022-07-27 |
Last Update Date | 2023-09-15 |