| NPI | 1639337942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.010937) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 591215-1) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209.010937) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209.010937) | |
| 163W00000X Registered Nurse (Licence: IL 041.409457) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2014-04-28 |