| NPI | 1891324083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021720) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 233324) |
| 163W00000X Registered Nurse (Licence: IL 041.383820) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2022-09-19 |