| NPI | 1437667490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2023006109) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2018001739) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 277.000663) | |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2023-03-10 |