| NPI | 1831687565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209024563) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: IL 041.461804) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2022-07-26 |