| NPI | 1952475329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 2027) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209004614) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-12-17 |