| NPI | 1477148443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.022492) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 77480) |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2024-06-24 |