| NPI | 1598263899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277.000785) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 99083662A) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2022-04-06 |