NPI | 1477315273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209028867) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.028867041.445528) |
Enumeration Date | 2024-01-26 |
Last Update Date | 2024-07-29 |