| NPI | 1720067051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209010226) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 005778) |
| 363L00000X Nurse Practitioner (Licence: MO 2013003629) | |
| 111N00000X Chiropractor (Licence: IL 038006559) | |
| 363L00000X Nurse Practitioner (Licence: IL 209010226) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2013003629) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2021-07-29 |