| NPI | 1689846693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 145838) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209005604) |
| 364SF0001X Clinical Nurse Specialist Family Health (Licence: MO 145838) | |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2020-10-22 |