| NPI | 1942652862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2016021256) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209016481) |
| Enumeration Date | 2016-07-02 |
| Last Update Date | 2022-12-05 |