| NPI | 1114490224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209017205) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209017205) |
| 163WE0003X Registered Nurse, Emergency (Licence: IN 28268975A) | |
| 363L00000X Nurse Practitioner (Licence: MI 4704285087) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ000891500) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71011442A) | |
| 163W00000X Registered Nurse (Licence: NJ 26NR20578200) | |
| 163WE0003X Registered Nurse, Emergency (Licence: IL 041389716) | |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2024-08-21 |