| NPI | 1467084038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209021033) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 041448442) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2024-10-17 |