| NPI | 1306689096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209029900) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 209-029900) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-11-07 |