| NPI | 1073233201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2022041567) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041480155) |
| 163W00000X Registered Nurse (Licence: MO 2018021776) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209026341) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2022-12-15 |