| NPI | 1699247874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277-002509) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60910192) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 277-002509) | |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2023-10-13 |