| NPI | 1821210287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209.001302) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 097839) |
| 163W00000X Registered Nurse (Licence: IL 041-201910) | |
| 363LF0000X Nurse Practitioner Family (Licence: MO 097839) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-12-16 |