| NPI | 1639801533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: IL 209.025417) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: IL 041384019) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2022-08-29 |