| NPI | 1487287793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209020538) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.020538) |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2021-04-07 |