| NPI | 1902056138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.009553) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: IL 000593533) |
| 163W00000X Registered Nurse (Licence: IL 041.336590) | |
| 163W00000X Registered Nurse (Licence: MO 2007005874) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2012-06-26 |