| NPI | 1316539182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209021862) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041438573) |
| 227900000X Respiratory Therapist, Registered (Licence: IL 194008069) | |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2021-02-03 |