| NPI | 1205266947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95010315) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209010824) |
| 163W00000X Registered Nurse (Licence: IL 041.292254) | |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2020-08-11 |