NPI | 1003699307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.028553) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.426288) |
Enumeration Date | 2023-08-18 |
Last Update Date | 2023-10-27 |