| NPI | 1518693076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.025761) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 041396403) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-08-17 |