| NPI | 1922451681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209014394) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.014394) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2026-03-17 |