| NPI | 1598177628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209011664) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1019749) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A136114) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024171692) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R217017) | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2016-04-21 |