| NPI | 1609252444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209019322) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2016014178) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2019-10-10 |