| NPI | 1669012837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209-020706) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209020706) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2025-02-26 |