| NPI | 1063889244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704250400) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209013187i) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209013187) | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2021-02-03 |