| NPI | 1477020246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209018624) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11044490) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95013514) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A177284) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2026-01-08 |