| NPI | 1902436801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95025035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 209020412) |
| Enumeration Date | 2020-01-19 |
| Last Update Date | 2023-08-01 |