| NPI | 1952029092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-4578) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209025736) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2025-07-18 |