| NPI | 1750338919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 135879) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209004468) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2007-11-07 |