| NPI | 1043585573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209009443) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 209009443) |
| 207P00000X Emergency Medicine (Licence: IA A151173) | |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2018-10-20 |