| NPI | 1306443056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA H161655) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IL 209022166) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: IL 209022166) | |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2024-12-02 |