| NPI | 1821048372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209004018) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MO 139341) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-06-03 |