| 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 |