| NPI | 1477983914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209-027530) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024186831) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1072803) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9347075) | |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2025-02-03 |