| NPI | 1952411449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209017761) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-007225) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-12-03 |