| NPI | 1609462068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209022079) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.022079) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2024-05-09 |