| NPI | 1558727636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.001430) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.009104) |
| 163WP0200X Registered Nurse, Pediatrics (Licence: IL 041430849) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209.020036) | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2024-10-29 |