| NPI | 1558148593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71014297A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209031541) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2025-05-14 |