| NPI | 1336534692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209012643) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.012643) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2021-12-01 |