| NPI | 1477383032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209031333) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2024030417) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-08-27 |