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 |