| NPI | 1437666294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209015936) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 209015936) |
| 363L00000X Nurse Practitioner (Licence: IL 209015936) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2017028743) | |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2019-01-03 |