NPI | 1669771861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209008721) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.008721) |
Enumeration Date | 2011-03-28 |
Last Update Date | 2022-04-18 |