| NPI | 1174870778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209009784) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA L-114465) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2021-11-15 |