| NPI | 1184092124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: IL 209012674) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95002286) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2019-08-26 |