NPI | 1679925887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277.002043) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.014449) |
Enumeration Date | 2016-07-12 |
Last Update Date | 2023-05-16 |