| NPI | 1427281336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-007857) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: IL 209005950) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2012-03-15 |