NPI | 1497311104 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.017752) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.301622) |
Enumeration Date | 2019-05-17 |
Last Update Date | 2023-07-05 |