| NPI | 1013918598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209002478) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IL 209.002478) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2022-12-15 |