| NPI | 1558826735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209018729) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.018729) |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2022-06-10 |