| NPI | 1720394612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0991852-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209008328) |
| 163W00000X Registered Nurse (Licence: IL 041363059) | |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2016-09-14 |