NPI | 1801358163 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11027868) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 277000948) |
363LF0000X Nurse Practitioner, Family (Licence: KY 3013324) | |
363LF0000X Nurse Practitioner, Family (Licence: IL 209.019260) | |
Enumeration Date | 2019-04-04 |
Last Update Date | 2024-01-08 |