| NPI | 1407309982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209014609) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 155120-30) |
| 163W00000X Registered Nurse (Licence: IL 041357363) | |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2018-07-17 |