| NPI | 1114532611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209021968) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041435789) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209021968) | |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2023-10-25 |