| NPI | 1508957788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209-001343) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041-295140) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2013-04-12 |