| NPI | 1881912392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209017468) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: IL 209008150) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2019-08-23 |