| NPI | 1770023608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2017004981) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209016013) |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2023-05-16 |