| NPI | 1477060895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209017063) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209017063) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2025-01-30 |