| NPI | 1497311104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.017752) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.301622) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2023-07-05 |