| NPI | 1669963765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009967A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209017691) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2020-04-23 |