NPI | 1811660533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209023162) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 28294630A) |
Enumeration Date | 2021-07-28 |
Last Update Date | 2025-07-16 |