| NPI | 1033535968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2013042094) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209011344) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2024-08-12 |