| NPI | 1093055402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209013655) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2013004685) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209013655) | |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2023-01-31 |