| NPI | 1457087900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209-025284) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 15020) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209-025284) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 041449223) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209025284) | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2024-10-23 |