| NPI | 1669003273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209026805) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704288263) |
| Enumeration Date | 2020-02-01 |
| Last Update Date | 2024-02-06 |