| NPI | 1164015848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209022888) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.402567) |
| Enumeration Date | 2021-02-14 |
| Last Update Date | 2025-04-16 |