| NPI | 1205237104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209019688) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041453293) |
| 225100000X Physical Therapist (Licence: IL 070020199) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 277001733) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277001733) | |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2023-07-31 |