| NPI | 1588620793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A-128168) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209005824) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 23734) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2015-08-24 |