| NPI | 1619233525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2012005560) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71009515A) |
| 363L00000X Nurse Practitioner (Licence: IL 209.011435) | |
| 363L00000X Nurse Practitioner (Licence: MO 2007022814) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2022-02-18 |