| NPI | 1922401819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006347) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209011966) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2022-07-21 |