| NPI | 1487303491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209026550) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 13276-33) |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2024-01-17 |