| NPI | 1003622242 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209031294) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2025-01-29 |