| NPI | 1679900195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209015952) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041371933) |
| Enumeration Date | 2013-09-29 |
| Last Update Date | 2022-05-02 |