| NPI | 1366676090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209.007535) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209007535) |
| Enumeration Date | 2009-05-10 |
| Last Update Date | 2022-02-10 |