| NPI | 1558534008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 277.004299) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 277.004299) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 17425) | |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2025-07-21 |