| NPI | 1922529080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011419) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209016137) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2025-03-21 |