| NPI | 1750981981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.028077) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: IL 41393748) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2023-11-01 |