| NPI | 1720861354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.028458) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: IL 041.412588) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-10-17 |