| NPI | 1245988781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5021066) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 101031-875) |
| 363L00000X Nurse Practitioner (Licence: IL 209023782) | |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-10-30 |