| NPI | 1407517394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.024878) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041446156) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2023-02-03 |