| NPI | 1629011846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 155854) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 155854) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209004407) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-06-21 |