| NPI | 1275972655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209.010975) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60362423) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209.010975) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2022-04-08 |