| NPI | 1649872367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.022385) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209.022385) |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2020-12-06 |