| NPI | 1528602646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.023750) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.444842) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2021-08-12 |