| NPI | 1316294580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IL 209.010371) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 209.010371) |
| 363L00000X Nurse Practitioner (Licence: IN 71009123A) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: IL 209010371) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2021-10-12 |