| NPI | 1427566454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209027448) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209027448) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209027448) | |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2024-03-05 |