| NPI | 1922703487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209027034) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 10068) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2023-08-11 |