| NPI | 1588206239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209019580) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 99094647A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71009659A) | |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2022-10-11 |