| NPI | 1649766288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021027097) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.017506) |
| 363L00000X Nurse Practitioner (Licence: IL 209017506) | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2026-04-29 |