| NPI | 1649864828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.021866) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.021866) |
| Enumeration Date | 2021-02-27 |
| Last Update Date | 2023-03-07 |