| NPI | 1528787744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.025563) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2023036829) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2023-11-06 |