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 |