| NPI | 1477389773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209030497) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 209030497) |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2025-01-30 |