| NPI | 1932518677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000026918) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209012419) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2023-08-02 |