| NPI | 1922302140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28149900a) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 041330644) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2022-08-11 |