| NPI | 1912420977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007278A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 041567917) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2025-02-06 |