| NPI | 1285228213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2020018086) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60944314) |
| 163W00000X Registered Nurse (Licence: IL 041500644) | |
| 163W00000X Registered Nurse (Licence: MO 2013025076) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209022160) | |
| Enumeration Date | 2021-02-20 |
| Last Update Date | 2021-07-19 |