| NPI | 1467446930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277001115) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71001336A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209-004145) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71001336A) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2024-05-22 |