| NPI | 1891532214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95031087) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209029790) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2025-04-16 |