| NPI | 1598308090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-243450) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.019558) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2025-01-24 |